In a first-of-its-kind partnership, Koch Eye Associates is opening a new diagnostic center today that will allow Rhode Island patients to get expert evaluations and treatment advice from the Joslin Diabetes Center in Boston without ever leaving the Warwick campus.
Nearly 80,000 Rhode Island adults have diabetes, according to the R.I. Department of Health, and with it comes a heightened risk of going blind. Nationwide, diabetes takes as many as 24,000 people’s vision each year, the leading cause of new blindness in people ages 20 to 74.
About one-fifth of people newly diagnosed with diabetes already have diabetic retinopathy, retinal blood vessel damage that can lead to blindness, according to the American Diabetes Association. And almost all patients will eventually develop the condition to some degree.
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The damage is irreversible, but there are “excellent treatment options” if you catch the problem early, said Gene Hopper, director of business development for the Joslin Vision Network. The trick is getting the proper eye care, and 40 percent to 60 percent of diabetics don’t. Because often there are no symptoms, patients may not know they’re in danger until they suddenly go blind. Most eye doctors also don’t have the expertise to diagnose the problem at an early stage, Hopper said.
Clinicians at Joslin’s Beetham Eye Institute do have that expertise, and to expand their reach, they’ve developed a system to have images of a patient’s retina to be captured wherever the patient is, then transmitted electronically to Joslin for evaluation.
The system is on par with the “gold standard” of in-person care, Joslin officials say, using a protocol that was previously available only to patients in clinical trials. It’s already been proven in collaborations with more than 40 federal health care facilities in 15 states, as well as the Joslin Diabetes Center Affiliate in Bahrain.
The new partnership with Koch takes the network to the next level: private-sector eye care in the heart of a state with tens of thousands of potential patients. “Because there is such an epidemic, there is an enormous opportunity,” Hopper said.
For Koch Eye Associates, on the other hand, the partnership is a chance to gain “world-class expertise” in a critical area, as CEO Peter Koch put it, and reach out to a new demographic.
But the Joslin affiliation doesn’t come cheap: Koch wouldn’t say how much the company is investing in the new facility, but he acknowledged it’s a large amount of money that will take “awhile” to recover. Hopper also noted that along with the photographic equipment, Koch Eye Associates is setting up a basic lab to do blood tests, an extra expense that will increase the value to patients of the services provided by the center.
The risks associated with retinopathy rise with the severity of the diabetes and with high blood pressure, so a Koch technician will test every patient’s hemoglobin A1C level and blood pressure in conjunction with the imaging procedure, adding to the information the Joslin experts have to base their diagnoses and treatment recommendations.
Once the results come back – within 48 hours, Koch said – Koch Eye Associates staff will share the results with the patient and ensure they get the care they need.
“We don’t have to spend a long time doing the things that we’re not particularly trained to do” – the retina tests, said Dr. Arthur Geltzer, who will oversee the diabetes center. “We are trained to evaluate the material we obtain through telemedicine, and we’re trained to treat it.”
“We’re using (Joslin) as a medium, if you will,” Geltzer added. “The decisions will be made with our advice by the patient’s medical doctor, if they have one, or else we’ll make sure they get one.”
With 80,000 patients at nine locations in Rhode Island and Connecticut, Koch has a built-in audience for the new service – a database review found 2,800 known diabetics, though Koch and Geltzer said they believe there are many more. Most insurance plans will cover the procedures to be offered at the facility, Koch said, so it won’t be a financial strain on patients.
But Koch is also committed to reaching diabetics who don’t have insurance, and maybe aren’t even getting regular eye care or medical care.
“The point of this program is really to reach and better serve the people that are being underserved,” Geltzer said. “Our concern is about the people out there who have not had the benefit of a good doctor and an eye program like we have here.”
“We didn’t get involved in this to separate out those who can pay us and those who cannot,” said Koch. “We realize there is a problem with diabetes in this state, and we brought in a partner who we think is the best in the world to help us (address) that.”
